CLINICAL SERVICES

​

All therapy appointments will be 45-60 minutes in duration either in-person in an office setting or virtual appointments referred to as “Telehealth.” You are responsible for paying for your appointment at the time of your session regardless of in-person or telehealth session types. Copays or Co-insurances must be paid on the date of service, or you may be asked to reschedule your appointment. Payment must be made by check, cash, or credit card.  Check payments that are returned for insufficient funds will generate a mandatory $25.00 bounced check fee in addition to the original payment amount.

 

One-time Assessments

Substance Abuse Assessment (ASAM)             $250

Mental Health Assessment                             $250

Sexual Behavior Risk Assessment (SBRA)         $500

Sexual Behavior Assessment (SBA)                 $500

 

Therapy Visit Fees

Initial Intake Evaluation (1st Appointment)       $150

Individual Therapy Appt 45-60 min                $120 

Family Therapy 45-60 min                             $120

Group therapy 45-60 min                              $50

​

Sliding Scale: Anyone with or without insurance can opt to use the sliding scale by providing the front office with proof of income through recent pay stubs or tax forms. If choosing the sliding scale option, QYS will NOT bill insurance. Please contact the front office if you would like to use the sliding scale and submit Proof of Income.

​

Payment Plans: You may enroll in a payment plan that will bill a credit card on file a set amount once per month instead of at the time of each session. Past due balances will be offered a payment plan option prior to any account being transferred to collections.

​

Insurance: If you have a health insurance policy, it may provide some coverage for mental health treatment. With your permission, QYS will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you are responsible for knowing your coverage and for letting the front office know if/when your coverage changes. Member responsibility of the total charge is determined by your insurance policy. Any information provided by QYS regarding your insurance policy is not a guarantee of payment and any balance due after insurance has processed the claim with be your financial responsibility.

​

Covered and Non-Covered Services: When your therapist is in network, they have a contract with your insurance company. Your insurance plan may cover all or part of the cost of therapy. You may be responsible for any part of this cost that is not covered by insurance, such as deductibles, copays, or coinsurance. You may also be responsible for any services not covered by your insurance. When your therapist is out-of-network, they do not have a contract with your insurance company, and you will be expected to pay the associated fees as outlined above at the time of the session.  

​

Payment Methods: This agency requires that you keep a valid credit or debit card on file. This card will be charged for the amount due at the time of service and for any fees you may accrue unless other arrangements have been made with the practice ahead of time. It is your responsibility to keep this information up to date, including providing new information if the card information changes or the account has insufficient funds to cover these charges. If your payment method is declined, you will receive a $25.00 failed payment fee.

​

Administrative Fees: Your therapist may charge administrative fees for: writing a letter or report at your request; consulting with another healthcare therapist or other professional outside of normal case management practices; or for preparation, travel, and attendance at a court appearance. Participation Payment is due in advance.

​

Refund Policy: Should Quality Youth Services owe you money in the event of an overpayment, the Practice will issue a Check to the client or their legal guardian if they are a minor for the overpaid amount. Quality Youth Services will not refund payments for services rendered.

​

To file a complaint/grievance if you feel your rights are violated:

• You can file a complaint by contacting the Practice using the following information:

  • Quality Youth Services 2240 N HWY 89 STE C Harrisville, UT 84404 (877) 393-6232 EXT 0

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave. S.W. Washington D.C. 20201

  • The Practice will not retaliate against you for filling a complaint.

  • You may also contact the Utah Office of Licensing (801) 538-4242

 

Client Eligibility: Clients accepted into Outpatient Mental Health Services with Quality Youth Services/QYS Clinical Services will only require the level of care of outpatient services. Clients will be deemed appropriate for an outpatient setting if they have no active suicidal ideation or active substance abuse that may keep them from staying safe in an outpatient setting. QYS clients that require a TAL or Proctor placement will be deemed eligible for Outpatient Therapy with Wrap Services if their Needs Assessment or PRA indicates it is the appropriate level of care. QYS may accept NOJOs clients with a level 4 or lower for a TAL/Proctor placement and a NOJOS level 1 and 2 for outpatient mental health services. Clients will be disqualified from outpatient mental health care if they belong to one of the following populations as their primary presenting problem: 1. Domestic Violence as the Perpetrator 2. Substance Abuse 3. Adult Sex Offender 4. Active Suicidal Ideation.